This research sought to determine the occurrence rate and morphological features of middle mesial (MM) canals in mandibular first molars across an Indian cohort, stratified by the nation’s various geographical regions, using cone-beam computed tomography (CBCT) imaging. Based on specified inclusion and exclusion benchmarks, 452 CBCT scans were gathered in December 2021. The images were obtained from five distinct regions of the country, with 80–100 scans from each region. An axial plane assessment was conducted to identify the existence of an MM canal (MMC); whenever spotted, confirmation was subsequently carried out in the coronal plane. Of the 452 scans reviewed, 39 showed MMCs, yielding a 8.6% rate. A bilateral manifestation was recorded in 8 scans (1.8%). Accordingly, of the 904 molars assessed, 47 had MMCs. This translates to a tooth-based prevalence of 5.2% for MMC. Among the teeth harboring MMCs, 70% concluded with two apical exits. Male subjects had a higher prevalence than females (10.25% vs. 6.88%, P < 0.05). A steady reduction in MMC detection was also noted with advancing age (P < 0.05). The prevalence of MMCs in this Indian sub-population is 8.6%. Despite being on the lower end of the spectrum relative to other groups, thorough inspection remains crucial to prevent overlooking the MMC, which could compromise treatment success. Age and sex were also recognized as influential variables affecting MMC presence.
